States to nearly $17 billion in 1994. These cost estimates underscore the enormous burden of STDs on the U.S. economy. They also represent compelling evidence of the need for effective STD prevention programs, especially in light of the fact that a sizable proportion of the direct costs of STDs results from failure to detect and effectively manage STDs in the initial, acute stage. For example, nearly three-fourths of the $1.5 billion cost of chlamydial infections is due to preventable consequences of untreated, initially uncomplicated infections (Washington et al., 1987; Appendix D).

Sources of Payment for STD-Related Costs

There are limited data regarding who pays for the costs associated with STDs. A study of payment sources for pelvic inflammatory disease from 1983 through 1987 found that private insurance and public payment sources covered 41 and 30 percent, respectively, of the direct costs associated with this STD (Washington and Katz, 1991). During the study period, the proportion of payments from private insurance decreased from 54 to 41 percent. Another study in a Midwest county hospital in 1984 and 1985 showed that 54 percent of total charges associated with pelvic inflammatory disease were not reimbursed by a third-party payer or by county funding to the hospital (Nettleman and Jones, 1989).

Conclusions

STDs affect persons of all racial, cultural, socioeconomic, and religious groups in the United States. Persons of all sexual orientations and sexually active persons in all states, communities, and social networks are at risk for STDs. These diseases are a tremendous health and economic burden on the people of the United States. STDs predominantly affect otherwise healthy youth and young adults, but the consequences can be lifelong. This impact is largely unrecognized by the public and even some health care professionals. Severe complications of STDs include cancer, reproductive health problems, neurologic diseases, and sometimes death. Women and their infants bear a disproportionate burden of these STD-associated complications. The committee estimates that the total annual cost associated with major STDs is approximately $10 billion, which rises to $17 billion when sexually transmitted HIV infections are included. The large number of STD-related deaths and morbidity, and the high costs of managing STDs and their complications, in the United States underscores the importance of effective prevention programs for STDs. Many cases of cancer, infertility, spontaneous abortions, low birth weight, STD-related deaths, and other STD-related conditions are clearly preventable. These data justify investing in effective STD prevention programs to both reduce human suffering and contain health care costs.

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